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PubMedDate not supplied

Open reduction and internal fixation for supracondylar humerus fractures in children.

Eight hundred sixty-two supracondylar humerus fractures were treated between January 1984 and July 1997. Sixty-five (8%) patients were managed with open reduction and internal fixation with pins. The remaining 797 patients (92%) were managed with either casting, closed reduction with or without percutaneous pinning, or traction. Of the 65 patients managed with open reduction, 46 (71%) of these fractures were irreducible, 16 (24%) had associated vascular compromise, eight (12%) were open, and one was associated with a postreduction nerve palsy and nonanatomic reduction. According to the criteria of Flynn et al. 18 (55%) elbows were rated excellent, eight (24%) were rated good, three (9%) were rated fair, and four (12%) were rated poor after an average of 5.8 months postinjury. This study indicates that highly satisfactory results can be obtained in severely displaced fractures managed with open reduction in these situations.

Adolescent↗
PubMed2001

Sonographic differentiation of stable and unstable lateral condyle fractures of the humerus in children.

Fractures of the lateral humeral condyle in children may cause difficulties in diagnosis and treatment. The fracture line involves the cartilaginous trochlea, which cannot be visualized on conventional radiographs. Therefore, a differentiation is not possible between the conservatively treated stable and the surgically treated unstable fracture, which involves the joint surface but is not dislocated primarily. We performed high-resolution ultrasonography in six children (age, 4-9 years) with a lateral condyle fracture of the humerus and uncertain joint involvement. Ultrasonography was able to visualize the fracture line through the joint surface in two children. Additional three-dimensional information could be gained that helped to plan further surgical procedures. The sonographic findings were confirmed intraoperatively and by magnetic resonance imaging in one child. In the remaining four children, ultrasonography was able to rule out joint involvement, thus classifying the fracture as stable. Conservative treatment was started, and the sonographic findings were confirmed by radiographs 4 days after the trauma to rule out secondary displacement. High-resolution ultrasonography is able to diagnose fracture involvement of the joint forming cartilaginous trochlea humeri in children, thus making further invasive or costly investigations such as magnetic resonance imaging unnecessary.

Cartilage, Articular↗
PubMedDate not supplied

Fracture stability after pinning of displaced supracondylar distal humerus fractures in children.

Between January 1, 1994 and December 31, 1997, we evaluated 138 children with displaced supracondylar distal humerus fractures treated by closed reduction and percutaneous pinning. There were 49 type II fractures and 89 type III fractures. Three principal pin configurations were used at the surgeon's discretion: 2 lateral pins (42 fractures), 1 medial and 1 lateral pin (37 fractures), and 1 medial and 2 lateral pins (57 fractures). There was no statistically significant difference in clinical stability between these groups. One type III fracture pinned using two lateral pins showed marked rotational instability. We recommend using two lateral pins when treating type II fractures. Type III fractures should be treated using two lateral pins initially and, if the elbow demonstrates significant intraoperative rotational instability, a medial pin should be added. If a medial pin is necessary, and the ulnar nerve cannot be identified by palpation, a small incision should be made and the pin placed under direct vision.

Adolescent↗
PubMed1975

Fracture of the medial condyle of the humerus.

Nine patients with ten fractures of the medial condyle of the humerus were reviewed after an average follow-up of 5.2 years. These avulsion fractures are unstable and there is a definite risk of nonunion. When the condylar fragment was rotated, open reduction and suture with catgut gave bad results. Rigid internal fixation is recommended.

Adolescent↗
PubMedDate not supplied

Infected nonunion of the humerus.

Eight patients with infected nonunion of the humerus were treated surgically by removal of the instrumentation, surgical debridement or wide resection of the fracture site and stabilization in compression with an external fixator. A monoaxial external fixator was used in 5 patients, a circular external one in 3. The amount of time between trauma and treatment described was a mean of 13 months. Consolidation occurred in all of the patients after an average of 5.5 months. Long-term follow-up was obtained after a mean of 18 months (minimum 14, maximum 35). There was postoperative paralysis of the radial nerve in 2 of the cases, with complete recovery after 3 months. One case consolidated despite the persistence of a fistula.

Adult↗
PubMed2001

Treatment of supracondylar humerus fractures in children: minimal possible duration of immobilization.

In the period from January 1980 until December 1990 we treated 147 children and adolescents with supracondylar humerus fracture, and followed the outcome in 127 of them. Three (2.4%) patients had no displacement of fractured bones and were treated only with plaster cast immobilization. Twenty three (18.1%) underwent closed reduction of fragments and application of a plaster cast. The majority (97; 76.4%) required manual reduction and the fixation of segments with Kirschner's wires laterally and medially. Four (3.1%) patients were treated with open reduction and fixation with Kirschner's wires. Both plaster cast immobilization and fragment fixation with Kirschner's wires lasted only 14 days and were immediately followed by rehabilitation. Such a short immobilization of extremities or fixation offragments did not result in any complication. Of 56 children available for long-term follow-up, we achieved excellent treatment results in 43 (76.6%) of the patients, good and fair in 12 (21.5%), and a poor result in only 1 patient (1.8%). There were no permanent vascular or neurological complications apart from slight weakness of the ulnar nerve in 3 patients. In conclusion 14 days seemed to be the biological minimum of time needed for this type offracture to heal in children and adolescents. Fixation of the fragments with Kirschner's wires and immobilization of the extremity for only 14 days brings a significant reduction of total treatment expenses, avoids repeated x-ray examination, facilitates early physical therapy and returns the child to its family.

Adolescent↗
PubMed2001

Plate osteosynthesis of the humerus shaft fracture an its association with radial nerve injury--a retrospective study in Melaka General Hospital.

Over a seven-year period, 170 cases of humerus fractures were plated in Hospital Melaka. Of these, 131 cases were successfully traced for this study. Besides looking at fracture epidemiology, its relationship with radial nerve injury was examined. The incidence of post-traumatic wrist drop in closed and compound fractures were 14.9% and 35.3% respectively. In relation to the site of fracture, lower third fracture had the highest incidence of wrist drop (29%). The recovery from post-traumatic wrist drop was 83%. The average duration taken for recovery was 11.8 weeks. The incidence of post-operative wrist drop was high at 17.6% but all recovered during follow-up.

Adolescent↗
PubMed2001

Metastatic involvement of the humerus: a retrospective study of 51 cases.

The authors performed a retrospective review of 53 patients with 56 completed or impending pathological fractures of the humerus. Sixteen cases were treated with a proximal and one with a distal humeral prosthesis, 38 with an intramedullary device with cement and one with plate fixation. Forty-eight patients with 51 humeral metastases were available to follow-up. No or only occasional pain was observed in 92% of the operated extremities and adequate postoperative function in 90%. No major complications occurred, except one rod migration.

Adult↗
PubMedDate not supplied

Delayed treatment of type 3 supracondylar humerus fractures in children.

A retrospective review of 158 type 3 supracondylar humerus fractures was undertaken to determine whether any correlation exists between an increased time from injury to surgery and four unfavorable results: a longer operative time, an increase in hospital stay, an increase in the need to open the fracture, or an increase in unsatisfactory outcomes. The average age of the patients was 5.0 years. Five children had nerve injury on initial examination, and no arm was poorly perfused. The average time from injury to evaluation in the emergency department was 9.8 hours and the average time from the emergency department to surgery was 11.5 hours. The average total time from injury to surgical treatment was 21.3 hours. The patients were in the hospital between 1 to 6 days. The average operative time was 53 minutes. Thirty patients had unsatisfactory results, defined as a pin infection, more than 15 degrees loss of motion in any plane, loss of normal carrying angle, neuropraxia, or retained hardware. There was no correlation between an increase in time to surgical intervention and longer operative time or need to open the fracture site, nor was there an indication that the delay to surgical treatment resulted in a longer hospital stay or an increase in unsatisfactory results.

Arm↗
PubMedDate not supplied

The surgical treatment of supracondylar fractures of the humerus in children by percutaneous fixation using Kirschner wires: analysis of residual deformities.

The authors report the results of the surgical treatment of supracondylar fractures of the humerus during childhood by closed reduction and percutaneous synthesis using Kirschner wires. A total of 16 patients were considered, who were re-examined at a mean follow-up of 57.9 months (24-84). The fractures were evaluated according to the Gartland classification modified by Wilkins. The results were classified based on Flynn criteria, and the duration of hospitalization and early and late complications such as neurovascular deficit and residual deformities were also taken into consideration. Final results were satisfactory in 94% of cases with no septic, vascular, or nervous complications. We observed remodeling of three fractures with defect in reduction of the distal fragment on a sagittal plane, and the absence of correction in a case of deficit in reduction on the frontal plane. Deformity persisted with no secondary displacement in 5 cases with correct postoperative reduction.

Adolescent↗
PubMedDate not supplied

Fractures of the humerus treated by elastic nailing.

The Marchetti-Vicenzi elastic nail was used in the osteosynthesis of 15 diaphyseal or metadiaphyseal fractures of the humerus, 14 cases achieved consolidation, 1 resulted in nonunion. Surgical approach was always distal, transtricipital and the nail was always locked distally. In the cases that healed, the mean radiographic consolidation time was 90 days. There were no immediate postoperative complications.

Adolescent↗
PubMedDate not supplied

Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus.

This study evaluated forearm compartment pressures in 29 children with supracondylar humerus fractures. Pressures were measured before and after reduction in the dorsal, superficial volar, and deep volar compartments at the proximal 1/6th and proximal 1/3rd forearm. Pressures in the deep volar compartment were significantly elevated compared with pressures in other compartments. There were also significantly higher pressures closer to the elbow within each compartment. Fracture reduction did not have a consistent immediate effect on pressures. The effect of elbow flexion on post-reduction pressures was also evaluated; flexion beyond 90 degrees produced significant pressure elevation. We conclude that forearm pressures after supracondylar fracture are greatest in the deep volar compartment and closer to the fracture site. Pressures greater than 30 mm Hg may exist without clinical evidence of compartment syndrome. To avoid unnecessary elevation of pressures, elbows should not be immobilized in >90 degrees of flexion after these injuries.

Adolescent↗
PubMedDate not supplied

Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques.

Supracondylar humerus fractures are a common childhood occurrence. Displaced fractures are typically treated with closed reduction and percutaneous pinning. Controversy continues over the appropriateness of various pinning techniques. The most common include crossed or lateral pins. A biomechanical comparison of crossed pins, "parallel" lateral pins, and "divergent" lateral pins was performed using a pediatric synthetic bone model. Mechanical testing of each pin configuration was performed in extension, varus, valgus, internal rotation, and external rotation. The divergent configuration provided statistically greater stability than parallel pins under varus and valgus loading. Divergent pins had similar stability compared with crossed pins in extension, varus, and valgus testing. In axial rotation testing, crossed pins were more stable. If the surgeon feels confident in the ability of lateral pins to provide satisfactory fracture stability, divergent lateral pins provide greater stability than parallel lateral pins while avoiding ulnar nerve injury (associated with crossed pins).

Analysis of Variance↗
PubMed2003

Complications after hemiarthroplasty for fractures of the proximal humerus.

Humeral head replacement is frequently used in the treatment of selected fractures of the proximal humerus. This technique is usually successful in terms of pain relief and patient satisfaction. However, complications may occur and can adversely affect outcome. Careful preoperative planning, meticulous surgical technique, and appropriate postoperative rehabilitation are the best methods to promote a successful result. Potential complications and methods to avoid them at initial surgery should be reviewed.

Arthroplasty, Replacement↗
PubMed2003

Late sequelae of proximal humerus fractures.

Proximal humerus fractures, both minimally displaced and complex, are subject to the development of complications. Late sequelae of such injuries include refractory shoulder stiffness, osteonecrosis, malunion, nonunion, and heterotopic bone formation. A prompt, accurate diagnosis and proper treatment protocol can decrease the occurrence and severity of such complications. When complications do occur, treatment options to improve outcome should be implemented.

Fracture Fixation↗
PubMedDate not supplied

[A method of osteosynthesis in supracondylar transverse fracture of the humerus in children].

A new surgical technique is described for the osteosynthesis of the supra-condylar transversal fracture of the humerus in children with an unique central transolecranian and transcondylar brooch. Intra-operative radiography is indispensable. The position for immobilization is very important. Temporary perforation of the diarthrodial cartilage and of the conjugation cartilage does not lead to functional or osteogenesis disturbances.

Child↗